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Polytrauma

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polytrauma management

polytrauma management

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  • 1. Management of polytrauma patients at POF Hospital Dr.Monsif Iqbal PGT SU-II
  • 2. Summary Case Presentation• Miss XYZ,a young lady 0f 23• RTA blunt trauma abdomen• Patient received in A & E• Patient then shifted to ITC
  • 3. Primary Survey Case presentation • Pulse….122 • BP……..80/55 • GCS……15/15 • Irritable • pallor • Cold & Clammy • Grade 3 shock
  • 4. FAST Case Presentation FAST performedFrank blood Shatteredin abdominal Spleencavity
  • 5. Management ResuscitationExploratory Laparotomy
  • 6. Resuscitation Case Presentation• I/V cannulae• Blood grouping & cross match• Restoration of intra vascularvolume• catheterization• antibiotic• Blood transfusion
  • 7. Cont. Case Presentation Patient rushed to OT collapsed on OT table Successful CPR done blood transfusion Patient reverted back
  • 8. managementEXPLORATORYLAPAROTOMY
  • 9. Findings of exploratory laparotomy Case Presentation• Splenic injury ….grade 5• Renal injury…….grade 4• Lt colon crushed• Abdominal cavity full ofblood• Retroperitonealhematoma
  • 10. Definitive surgical treatmentFindings of exploratory laparotomy Case Presentation• Splenetomy• Nephrectomy Lt• Sigmoid Colostomy
  • 11. Post op recovery management • Mechanicl vent for 2 days • Drain output gradually reduced • Pneumovac given • Patient went into DIC with deranged PT & APTT • FFPs and platelets transfused • 7 blood transfusions done gradually • Stoma started working on 2nd POD
  • 12. Cont….. management• Patient gradually reovered• Urine output remained satistory• Wound….healthy• Stitches out on 11th POD• Patient discharged home on 13th POD
  • 13. DiagnosisManagement of polytrauma patients Resuscitation & definitive management
  • 14. Componenets ATLS • Primary survey • Resuscitation • Secondary survey • Definitive management
  • 15. Primary survey ATLS• A..airway & cervical spine care• B…Breathing & ventilation• C…circulation & hemorrhage control• D…Deformity & disability• E…exposure & environmental cond
  • 16. Adjuncts to primary survey ATLS • ECG • Urinary & Gastric catheters • ABGs • Pulse oximetry • X-rays & Diagnostic studies
  • 17. Secondary survey ATLS• History • Examination Blunt ?  Head & neck Penetrating ?  Chest Burn or cold  Abdomen injuries  Extremities  spine
  • 18. Adjuncts to secondary survey ATLS• Detailed X-rays• CT scan• Angiography• USG• Transportation
  • 19. Abdominal trauma
  • 20. Blunt Abdominal trauma
  • 21. Penetrating Abdominal trauma
  • 22. Laparotomy
  • 23. Focused Assessment with Sonography in Trauma FAST• FAST examines four areas for free fluid: – Morrison’s Pouch – Perisplenic – Pelvis – +/-Pericardium
  • 24. Morrison’s pouch
  • 25. How good is FAST? FAST• As a decision making tool for identifying the need for laparotomy in hypotensive patients (Systolic BP < 90), FAST has:• a sensitivity of 92%,• specificity of 96%• Accuracy 93%• How good is FAST?
  • 26. DPL
  • 27. Specific injuries Polytrauma• Spleen• Kidney• Liver• Intestine• Diaphragm• Pancreas
  • 28. Spleen
  • 29. Liver
  • 30. Liver injuries management• Push• Plug• Pack• pringle
  • 31. Kidney
  • 32. Gradesof renal injury
  • 33. Pancreas
  • 34. Intestine
  • 35. Damage control surgery
  • 36. Colon
  • 37. Diaphragmatic injury
  • 38. Statistics of trauma in POF HOspital from jan 2010- jan2011
  • 39. statistics polytrauma• Head injury….212• Blunt abdominal injury….67• Penetrating abdominal injury….17• Thoracic injury……27• Orthopedic inj…..89• Polytrauma …..56• Mortality…..24
  • 40. ortho
  • 41. Managementof Abdominal trauma Blunt abdominal traumaConservative Operativemanagement management 33 34
  • 42. FAST done…. polytrauma• Total…..57• Positive……30• Inconclusive…..11• Negative……16
  • 43. Head injury
  • 44. Mortality
  • 45. Take home message‘Multidisciplinary approach requiredfor management of polytraumapatient involving generalsurgeon,urlogist,orthpedicsurgeon,anesthetist,radiologist etc’

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